Assessing the Utilization

of Nursing Research in
Extended Care Facilities
ELLENOR CHANCE RN, BSN, FNP-S

Objectives

Discuss nursing research and evidence based practice.

Discuss the problem with nursing homes and research utilization.

Review research question

Review the literature on the utilization of nursing research in extended

care facilities.

Discuss the significance of the literature review

Discuss non-thesis research findings

Discuss future implications

Background

Nursing
Research
Evidence
Based Practice

Scientific process that validates existing

knowledge and generates new knowledge.
Directly and indirectly influences the
delivery of evidence based nursing

best research evidence to support clinical

decision making.
improve heath outcomes of patients.

Background

Nursing has become a professional practice with the use

of research and Evidence based practice.

Evidence based practice is known to increase quality of

care and patient outcomes.

However studies suggest that nurses are not using

research at the bedside instead they obtain information
from each other.

Background

Rogers Diffusion of Innovation Theory

Background

Barriers to Research Utilization

Lack

of interest

Lack

of time

Lack

authority to change practices

Inability

to understand research findings

Unsupportive

organizational climates

Background

Supportive nursing environments focus on activities

that develop nursing staff through education and
research.

Problem

There is little evidence on the utilization of nursing

research in Extended Care Facilities.

Problem

The quality of care in many U.S nursing homes remains less than
optimal.

Most notably the presence of pressure ulcers (important

indicator of the QUALITY of nursing home care) have
increased and now 11% of all nursing home residents have
pressure ulcers, of these 76% are stage 2 or higher.

Receive deficiency citations during federally mandated nursing

home inspections.

They continue to cycle in and out of deficiency status

No sustained adherence to mandated levels of quality care.

Problem

Over the next 25 years the number of individuals age 65 and

older will double.

Elder adult care cost is three to five times higher than young
adults.

Medicare spends about $336 million dollars in older adult care

annually

Admission rates is expected to rise along with cost by year 2050.

Many elder adults will at some point be faced with the decision to
enter nursing homes for care.

Research Question

Are nurses utilizing nursing research and current

evidence based practices in extended care facilities?

Literature Review

Literature Review was performed using CINHAL and OVID

search engines

key wordsUtilization, Research, and Nursing homes

Literature Review consist of 15 scholarly articles.

Reliable sources CDC, Healthy People 2020, and National

Nursing Homes Survey were used.

Literature Review

RECURRING THEMES:

Literature Review

Literature suggests suboptimal care in nursing home

residents in the following areas
Increased

ED admissions while under nursing

home care

Pressure ulcer acquisition while under nursing

home care

Literature Review
Falls
Poly

pharmacy

Poor

pain management

Literature Review

Deficient Areas
11%

9%
11%

20%

falls
pressure ulcer
poly pharm

50%

pain mgt
ED visits

Literature Review

Shorter hospital stays = Admission of sicker residents

Increased functional dependence

Co morbid conditions
(NHHS, 2004)

Literature Review
The

use of highly technical interventions

Only

1.6% of nursing home residents require no

assistance with ADLs

More

than half of all nursing home residents require

assistance or are totally dependent with all ADLs.

Literature Review

ADL Assistance

2 ADL's; 5.9

No ADL's; 1.6 unknown; 1.1

4 ADL's

3 ADL's; 6.3
4 ADL's; 27.5

5 ADl's

5 ADl's; 51.1

3 ADL's
2 ADL's
No ADL's
unknown

(NHHS, 2004)

Literature Review

International task force was convened to address the

gaps in clinical practice.

Recommendations focused on enhancing the reputation

of nursing homes through .
Strengthening

leadership, clinical practice, quality of

care, education and RESEARCH

Significance

Important to assess research utilization to ensure that

health care providers are meeting Healthy People
2020s goal of improving the health, function, and
quality of life in older adults,

Significance

Nursing home care is reportedly SUBOPTIMAL

Nursing environments that place emphasis on

EDUCATION and RESEARCH have positive effects on
QUALITY of care and patient outcomes.
***fewer deficiency citations and pressure ulcer
acquisition rates are lower.

Significance
INTERACT

(Interventions to Reduce Acute

Care Transfers)- clinical practice tool thats
used to reduce hospital admission rates.
Communicati
on
INTERACT
Documentati
on

Identify
Conditions
Evaluate and
treat
Prevent ED
admissions

Significance

Registered Nurses
Nurse Practitioners
Hospital admission
rates

Non-thesis Presentation Findings

Research

assessment tool was used to assess a small

group of nursing home nurses research utilization and
organizational support.
Comfortable

with research 60% YES other 40%

were NOT SURE

Non-Thesis Presentation Findings

Participated

in research projects 40% YES, 60%

said NO
Aware

of any research being conducted in their

work pace-60% NO, 20% yes, 20% NOT SURE

Do

you feel that your facility encourages

research 40% YES, 40% SOMEWHAT, 20% NO.

Need

to assess the utilization of research in

extended care facilities 100% YES.

Future Implications

Individuals are living longer with chronic illnesses and

co morbidities, and will at some point be faced with a
decision to enter into nursing home care.

Suboptimal care puts nursing home residents at risk

for pressure ulcers, falls, poly pharmacy, poor pain
management, and avoidable hospital admissions, all
of which decreases quality of care and increases
Medicare and Medicaid spending.

Future Implications

More information is needed on this subset of nurses

use of research to decrease the incident of deficiency
in areas that indicate quality of care in older adults.

References

Anderson, N., Jylli, L., Kajermo, K. N., & Klang, B. (2007). Nurses in pediatric care-self reported professional and perceived research utilization. Scand Journal of Caring Science, 426-433.
Baernholdt, M., & Lang, N. M. (2007). Government chief nursing officers' perceptions of barriers to using research on staffing. International Nursing Review, 54, 49-55.
Brown, C. E., Ecoff, L., Kim, S. C., Wickline, M. A., Rose, B., Klimpel, K., & Glaser, D. (2010). Multi-institutional study of barriers to research utlilisation and evidence-based practice
among hosptial nurses. Journal of Clinicical Nursing, 19, 1944-1951.
Brown, C. E., Wickline, M. A., Ecoff, L., & Glaser, D. (2008). Nursing practice, knowledge, attitudes and percieved barriers to evidence-based practice at an academic medical center. Journal
of Advanced Nursing, 65(2), 371-381.
Center for Disease Control and Prevention. (2007). Nursing home care. Retrieved from:
http://www.cdc.gov/nchs/fastats/nursingh.htm
Center for Disease Control and Prevention. (2007). The state of aging and health in America.
Retrieved from: http://www.cdc.gov/Aging/pdf/saha_2007.pdf
Chau, J. P.c., Lopez, V., & Thompson, D. R. (2008). A survey of Hong Kong nurses' perceptions of barriers to and facilitators of research utilization. Research in Nursing & Health, 31, 640649.
Flynn, L., Liang, Y., Dickson, G., & Aiken, L. (2010). Effects of Nursing Practice Environments
on Quality outcomes in nursing homes. The American geriatric society, 58, 2401-2406.
Healthy People (2012). Access to health services. Retrieved from:
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=1
Katz, P. R., Karuza, J., Intrator, O., & Mor, V. (2009). Nursing home physician specialist: A response to the workforce crisis in long-term care. Annals of internal medicine, 150(6),
411-413.

References
Mathews, J. (2012). Paying for nursing care. Retrieved from:
http://www.nolo.com/legal-encyclopedia/choosing-paying-long-term-care-29651-2.html
McCloskey, D. J. (2008). Nurses' perceptions of research utilization in a cooperate health care system. Journal of
Nursing Scholarship, 40(1), 39-45.
Mehrdad, N., Salsali, M., & Kazemnejad, A. (2007). The spectrum of barriers to and facilitators of research
utilization in Iranian nursing. Journal of Clinical Nursing, 17, 2194-2202.
Murray, C. (2009). Diffusion of innovation theory: A bridge for the research-practice gap in counseling. Journal
of Counseling & Developement, 87, 108-116.
National Nursing Home Survey. (2004) retrieved from:http://www.cdc.gov/nchs/data/series/sr_13/sr13_167.pdf
Ofi, B., Sowunmi, L., Edet, D., & Anarado, N. (2008). Professional nurses' opinion on research and research
utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. International Journal of
Nursing Practice, 14, 243-255.
Uysal, A., Temel, A. B., Ardahan, M., & Ozkahraman, S. (2010). Barriers to research utilization among nurses in
Turkey. Journal of Clinical Nursing, 19

Questions?